title: C-reactive protein as a marker of complicated diverticulitis in patients on anti-inflammatory medications.
abstract: BACKGROUND
  Diverticulitis is a common indication for surgical emergency room admission, often leading to abdominal computed tomography (CT) scanning for both diagnosis and staging. C-reactive protein (CRP) has been identified as a useful biomarker of inflammation. Aspirin and corticosteroids are known to down-regulate CRP production. In this study, we evaluated the usefulness of CRP as a biomarker for complicated diverticulitis and specifically in patients on anti-inflammatory medications: aspirin and corticosteroids.
  
  
  METHODS
  We analyzed the medical records of patients diagnosed at one medical center during a two-year period, with left-sided diverticulitis, according to clinical data and CT scan. Disease severity was assessed by the Hinchey score using the radiological findings detected by CT.
  
  
  RESULTS
  A total of 295 patients were included in the study. Two hundred and forty-three (82 %) were classified with uncomplicated (Hinchey 1a) and 52 (18 %) with complicated disease (Hinchey > 1a). Mean CRP levels were 133.5 and 63.5 mg/ml for those with complicated and uncomplicated disease, respectively (p < 0.001), and 139 and 60 mg/ml, respectively (p < 0.001) in the subgroup of patients taking aspirin (n = 61). For 14 patients on corticosteroid treatment, the difference in mean CRP levels for complicated and uncomplicated disease was not statistically significant. CRP > 90 mg/ml had 88 % sensitivity and 75 % specificity for complicated disease.
  
  
  CONCLUSIONS
  The CRP level distinguished between complicated and uncomplicated disease among left-sided diverticulitis patients including those taking aspirin, but not among those on corticosteroid treatment.
authors.affiliation: Department of General Surgery, Tel-Aviv Sourasky Medical Center, Weizman 6, Tel Aviv, Israel, erann@tlvmc.gov.il.
authors.forename: E
authors.initials: E
authors.lastname: Nizri
authors.forename: S
authors.initials: S
authors.lastname: Spring
authors.forename: A
authors.initials: A
authors.lastname: Ben-Yehuda
authors.forename: M
authors.initials: M
authors.lastname: Khatib
authors.forename: J
authors.initials: J
authors.lastname: Klausner
authors.forename: R
authors.initials: R
authors.lastname: Greenberg
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D004239:Diverticulitis, Colonic / Q000097:blood* / Q000145:classification / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed
chemical_list: D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D015415:Biomarkers; D002097:C-Reactive Protein; D001241:Aspirin